oncology nursing
DESCRIPTION
this is a copy of my old supplemental slides which I give to my students from almost 2 years ago . I don't use this at all at my lectures, simply because I don't rely on using slides during lectures... because lecturers must know their concepts by heart and must not read slides nor notes during the actual lecture presentation.TRANSCRIPT
diannemaydee
Oncology NursingBy:
DIANNE MAYDEE MANDAL RN, USRN, REMT-B, AREMT-B
http://http://stuffednurse.blogspot.comstuffednurse.blogspot.com
diannemaydee
LEUKEMIA
diannemaydee
• Types:
• Acute lymphocyte leukemia
- 80-85% of childhood leukemia
- Acute onset
- 95% chance of obtaining remission with
treatment
- 75% chance of surviving 5 years or more
- B. acute nonlymphocytic leukemia
- Include granulocytic and monotypic type
diannemaydee
• Acute nonlymphocytic leukemia
• Includes granulytic and monocytic type
• 30 40 % cure rate
• Assessment findings:
• Anemia
• Bleeding
• Infection
• Enlarged lympf nodes
• Enlarged spleen and liver
• Abdominal pain
diannemaydee
• 1. Danika, A child diagnosed with Leukemia has her laboratory results available. For it to coincide with the medical diagnosis, the nurse should not expect which of the following systemic changes in Danika’shematologic system?
• A. Thrombocytopenia
• B. Anemia
• C. Petechiae
• D. Leukocytosis due to decreased WBC
diannemaydee
• 2. Procedure in diagnosing leukemia:
• A. Histamine test
• B. Schilling test
• C. platelets count
• D. bone marrow examination
diannemaydee
• 3. Common hepatomegaly manifestation of leukemia is caused by:
• A. granulocytes
• B. lymphocytes
• C. histiocyte infiltration
• D. leukocyte infiltration
diannemaydee
• 4. She is receiving cytoxan. What is the temporary side effect of this drug?
• A. alopecia
• B. depression
• C. dysuria
• D. blurred vision
diannemaydee
• 5. Since he is on long-term antibiotic therapy. Which of these should you keenly observe?
• A. developing rashesB. developing systemic fungal
infection
• C. developing petechiaeD. developing fiber blister
diannemaydee
Leukemia• Pathology: abnormal proliferation of immature WBC that infiltrate
bone marrow and peripheral blood.• IN THE BONE MARROW, BLAST CELLS crowd out healthy blood
cells• Risk: benzene, arsenic, radiation, viral infection, genetics, Down’s
syndrome, chemotherapeutic agents. • Dx: bone marrow biopsy• Cardinal sign: anemia, infection, bleeding• DOC: steroids; chemotherapy: platinol, 5-FU, oncovin, iodotope• Nurse concern: signs of infection is absent because of
neutropenia; CNS manifestation is common in lymphocyticleukemia; Massive amount of chemo drugs is given a one time for Acute myelocytic leukemia; Protect from infection, bleeding and fatigue.� stomatitis is common: oral care� discuss fears with patient and support system
diannemaydee
LUNG CANCER
diannemaydee
• General Information
- Pulmonary tumors arise in bronchial epithelium and therefore are referred to as brocnhogenic carcinoma
- Pathologic changes include nonspecific inflammation with hyper secretion of mucous and obstruction.
- Metastasis occurs mainly by direct extension and thru the lymphatic system
- Men over 40 affected most and 1 of every 10 smokers affect right lung more than left.-
- Cause by inhaled carcinogens
diannemaydee
• Medical Management• Radiation therapy• Chemotherapy – usually includes methotroxate,doxorubicin,
procarbazine• Surgery when entire tumor can be removedassessment findings:- persisyent cough may be productive or blood tinged- chest pain, unilateral wheezing; friction rub, possible unilateral
paralysis of the diaphragm.-fatigue, anorexia, nausea,vommiting,pallor.Nursing Interventions:Provide support-pain medicationsrealistic information about prognosis
diannemaydee
• 4 KINDS:
• 1.Squamous cell carcinoma- most common in
men due to smoking
• 2. Aden carcinoma- lung cancer in women and
non smokers. Can be seen in alveolar parts of
the lung and usually connected with scarring
• 3. Small cell carcinoma- more on smoking
• 4. Large cell carcinoma- poor prognosis
because of their ability to metastasize
diannemaydee
• Thoracic Surgery:
• Types:
1. Exploratory thoracotomy-
2. Lobotomy
3. Pneumonectomy
4. Segmental resection
5. wedge resection-
diannemaydee
• Nursing Interventions: pre op
- Provide routine prop care
- Perform complete P.A. of the lungs as baseline data. explain post op measures care of incision site, O2, suctioning and chest tubes
- Teach client adequate splinting of incision
- Demonstrate ROM on the affected side
diannemaydee
• Post OP care:- Provide routine post op care
- Auscultator lung fields every 1-2 hrs.
- Perform suctioning when needed- Place client in semi fowlers position
- Provide pain relief- Prevent impaired mobility by passive exercises passive
on the day of surgery then active
- High protein diet- Avoidance of crowds and people with resp.tract
disorders-
diannemaydee
• 1. Mang Edgardo has a chest tube inserted in place after a Lobectomy. The nurse knows that that Chest tube after this procedure will:
• A. Prevents mediastinal shift
• B. Promote chest expansion of the remaining lung
• C. Drain fluids and blood accumulated post operatively
• D. Remove the air in the lungs to promote lung expansion
diannemaydee
• 2. After Lobectomy, Mang Edgardo is placed at:
• A. Affected Side
• B. Unaffected Side
• C. Left lateral position
• D. Right lateral position
diannemaydee
• 3. Extra care should be given when suctioning a patient after Pneumonectomy. The rationale behind this is that:
• A. Suctioning could place undue strain on the bronchial stump suture
• B. The patient will no longer have the ability to cough out the secretions
• C. The remaining lung will not be able to compensate for the oxygen being drawn by the suction
• D. Suctioning could cause perforation on the remaining functioning lung
diannemaydee
Lung CA
• Pathology: carcinogens mutate repiratory cells and undergoes metaplasia which progresses to carcinoma�
effusions, cushing’s, SIADH, DIC, anemia,
hypercalcemia, obstructions.
• Risk: Cigarette smoking
• Dx: CXR, MRI, sputum/ bronchoscopy cytology
• Cardinal sign: persistent cough, red sputum
• DOC: Mustargen ( alkylating agent)
other tx� surgery and radiation
• Nurse concern: Round the clock pain management; Kobler-Ross grieving process&therapeutics
diannemaydee
• Lung cancer: complications
“SPEECH”Superior vena cava syndromeParalysis of diaphragm (Phrenic nerve) Ectopic hormonesEaton-Lambert syndromeClubbingHorner syndrome/ Hoarseness
diannemaydee
LARYNGEAL
CANCER
diannemaydee
Cancer of the larynx• Etiology
– most tumors of the larynx are squamous cell carcinoma – more common among men, age 50 to 65 – cigarette smoking and alcohol consumption are related
• Findings – persistent sore throat – dyspnea– dysphagia– increasing persistent hoarseness – weight loss – enlarged cervical lymph nodes
diannemaydee
diannemaydee
Cancer of the larynx• Management
– radiation therapy
– chemotherapy
– surgery: removal of all or part of larynx to treat cancer
• total laryngectomy: no voice, permanent stoma in neck with no risk of aspiration from oral cavity
• radical neck dissection: when cancer has metastasized to surrounding tissues
diannemaydee
Cancer of the larynx• Nursing interventions – arrange for clients with larnygectomies to meet with members of support groups
– establish a method for communication before surgery
– maintain airway; have suction equipment at bedside
– observe for signs of hemorrhage or infection
– teach about trach and stoma care
– assist with period of grieving
diannemaydee
• Types:
- Supraglottic – also called extrinsic laryngeal cancer
- Involves the epiglottis and false vocal chords
- No symptoms until advance stage
- Glottis – most frequent
- produces early symptoms
- cigarette smoking, vocal abuse, family history.
diannemaydee
• Assessment Findings:
- Supraglottic – localized throat pain
- burning sensation when drinking hot and cold orange juice
- lump in the neck
- eventual dysphasia, muffled voice, dyspneic, weight loss, cough and hemoptysis
diannemaydee
• Glottic –progressive hoarsenes. Eventual dyspnea.
• enlarged cervical lymph nodes.
Interventions:
1. Partial laryngectomy – a lesion on the true chord on one side is removed
- client can still talk
2. Total laryngectomy – removal of the entire larynx, cricoid cartilage, 3-4 rings of the trachea
pharyngeal opening of the trachea is closed
diannemaydee
• - permanent tracheostomy is attached
• Result is loss of normal speech
• Loss of olfaction
• Loss of breathing
nursing care pre –op
explain expected procedures
introduce client to mode of communication like
gestures
diannemaydee
• Nursing Care post – op:
- promote optimum ventilatory status
- suction nose frequently because of allergic rhinitis
- provide pain relief
- elevate head of bed to decrease pressure on suture lines
- and to promote lympathic drainage
- Prevent infection
- assess non verbal communication
- need to use electric razors as the face area will be numb for 6 months
diannemaydee
• 1. Brix has tracheostomy. When suctioning and suctioning through laryngectomy tube. When doing these two procedures at the same time, the nurse would not do which of the ff:
• A. Use sterile technique
• B. turn head to right to suction left bronchus
• C. suction for no longer then 10 to 15 seconds
• D. observe for tachycardia
diannemaydee
• 2. Brix requires both nasopharyngeal suctioning and suctioning through laryngectomytube. When doing these two procedures at the same time, the nurse would not do which of the ff:
• A. use a sterile suction setup
• B. suction the nose first, then the laryngectomytube
• C. suction the laryngectomy tube first, then the nose
• D. lubricate the catheter with saline
diannemaydee
• 3. A nasogastric tube is used to provide Brix
with fluids and nutrient for approximately 10
days, for which of the following reasons?
• A. to prevent pain while swallowing
• B. to prevent contamination of the suture line
• C. to decrease need for swallowing
• D. to prevent need for holding head up to ear
diannemaydee
• 4. The client has orders for a nasogastric (NG) tube insertion. During the procedure, instruction that will assist in insertion would be:
• A. instruct the client to tilt his head back for insertion into the nostril, then flex his neck for final insertion
• B. after insertion into the nostril, instruct the client to extend his neck
• C. introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion
• D. instruct the client to hold his chin down, then back for insertion of the tube
diannemaydee
• 5. The nurse is correct in performing suctioning when she applies the suction intermittently during:
• A. Insertion of the suction catheter
• B. Withdrawing of the suction catheter
• C. both insertion and withdrawing of the suction catheter
• D. When the suction catheter tip reaches the bifurcation of the trachea
diannemaydee
• 6. The purpose of the cuff in Tracheostomy tube is to:
• A. Separate the upper and lower airway
• B. Separate trachea from the esophagus
• C. Separate the larynx from the nasopharynx
• D. Secure the placement of the tube
diannemaydee
• 7. The GAUGE size in ET tubes determines:
• A. The external circumference of the tube
• B. The internal diameter of the tube
• C. The length of the tube
• D. The tube’s volumetric capacity
diannemaydee
• 8. The tracheostomy is attached and secured by:
• A. Suturing it in place
• B. Tying it in place
• C. Taping it in place
• D. Inflating the cuff
diannemaydee
• 9. After a laryngectomy, a client, who is being discharged exhibits concern that the laryngectomy tube may become dislodged. The nurse should teach the client to first:
• A. Notify the physician at once
• B. Reinsert another tube immediately
• C. Keep calm because there is no immediate emergency
• D. Recognize that prompt closure of the tracheal opening may occur
diannemaydee
• 10. In caring for a patient with a tracheostomywhich of the following would be an INCORRECT ACTION by the nurse when providing tracheostomy care?
• A. Checking the cuff pressure
• B. Provide humidified oxygen
• C. Remove the outer cannula for cleaning q. shift
• D. Place sterile gauze between the outer wings of the tube before tying strings or tape to secure it
diannemaydee
• 11. You are assigned to teach a nursing student how to suction an adult patient with a tracheostomy. Which of the following actions by the nursing student would be INCORRECT?
• A. Pre-oxygenation of the patient with a Resusibag at 100% 02 several times before suctioning
• B. Maintains wall suction pressure at 110-150mmHG
• C. Does not suction for greater than 10-15 seconds at a time
• D. Applies gentle intermittent pressure and rotates catheter during insertion phase of suctioning
diannemaydee
PROSTATE CANCER
diannemaydee
Prostate Cancer
• Slow malignant change in the prostate gland that spreads by direct invasion of surrounding tissues & metastasizes to the bony pelvis & spine
• Most common site of cancer in men (21%)
• Dihydrotestosterone – only factor clearly associated with development of prostate cancer
diannemaydee
1. Incidence of prostate cancer in Asian countries is rising rapidly as reported by health bulletins, why is this?
a. increasing adoption of western lifestyle
b. Promiscuous behavior of men
c. Increase in drinking & smoking habits
d. Early detection
diannemaydee
2. With this awareness of prostate cancer, what is the good screening method that a nurse can suggest:
a. Annual physical check-up
b. Weight loss watching
c. X-rays & ultrasound analysis every 2 years
d. PSA analysis once a year
diannemaydee
3. Decisions for the treatment of prostate cancer depends on:
a. Nurse assessment advice to patients
b. Attending physician and his management staff
c. Pathology of the cancer & impact on quality of life
d. Age & health status of the person
diannemaydee
4. One of the latest discovery in the treatment of prostate cancer is:
a. Surgery
b. Anti-androgen
c. Chemotherapy
d. Radiation
diannemaydee
• Pathology: similar to BPH
• Risk: age, ethnicity, chemical exposures
• Dx: PSA more than 4.0; DRE, USG
• Cardinal sign: depends on stage:
A1= asymptomatic
B2= enlarged prostate
C3= urinary symptoms, rectal or pelvic pain
D4= ++ lymph, bone, liver, lung area pain
• \DOC: Hormone therapy and chemo-radiation Tx
Other Tx: TURP
• Nurse concern: testosterone dependent at early stage; client will become impotent if abdominal prostatectomy is done; age of client at diagnosis is usually 65; assess mouth for stomatitis, for signs of dehydration, and for suicidal tendencies; Support for body image or sexual issues.
diannemaydee
TESTICULAR CANCER
diannemaydee
• 1. Which of the following terms refers to surgical removal of one of the testes?
• A. Orchiectomy
• B. Circumcision
• C. Vasectomy
• D. Hydrocelectomy
diannemaydee
• Rare form of cancer
• Most common cancer in young men (15 – 35 y/o)
• Unknown cause
• High incidence in cryptorchidism or atrophic testis
diannemaydee
• Pathology: germ or stromal cell carcinoma, seminoma replacing parenchymal tissues.
• Risk: Hx of cryptorchidism, trauma, DES exposure, low birth weight, prematurity
• Dx: HCG, AFP, LDH
• Cardinal sign: painless, hard nodule on one side of testes. Usual metastases on lymph, lung, bone and GI.
• \DOC: Etopside (Vepesid) plus cisplatin chemo.
Other Tx: orchiectomy
• Nurse concern: IEC on sperm banking if client desires fertility and on TSE.
diannemaydee
CERVICAL CANCER
diannemaydee
• 1. When the results of a Pap smear are reported as class 5, the nurse recognizes that the common interpretation is:
• A. malignant.
• B. normal.
• C. probably normal.
• D. suspicious.
diannemaydee
• malignant.
• A class 5 Pap smear, according to the Bethesda Classification, indicates squamous cell carcinoma.
• normal.
• A class 1 Pap smear is interpreted as normal.
• probably normal.
• A class 2 Pap smear is interpreted as probably normal.
• suspicious.
• A class 3 Pap smear is interpreted as suspicious.
diannemaydee
• 2. For women aged 19-39 years, recommended health screening diagnostic testing includes which of the following?
• A. Pap smear
• B. Mammography
• C. Cholesterol and lipid profile
• D. Bone mineral density testing
diannemaydee
• Pap smear
• A Pap smear is recommended for women aged 19-39 years, as well as for women aged 40 and older.
• Mammography
• Mammography is recommended for health screening for women aged 40 years and older.
•
• Cholesterol and lipid profile
• Cholesterol and lipid profile is recommended for women aged 40 years and older.
• Bone mineral density testing
• Bone mineral density testing is recommended for women aged 40 years and older.
diannemaydee
• Pathology: ductal or lobular breast carcinoma that is hormone dependent� can be in-situ or invasive; inflammatory or Paget’s.
• Risk: family history, chest area radiation, americans, menarche before age 12 or menopause after 50, hormone therapy for 5 years, nulliparity, first pregnancy after 30, never breastfed, daily alcohol use, obesity.
• Dx: mammography, BSE, fine needle biopsy.
diannemaydee
• Cardinal sign: hard irregular painless, fixed mass or
thickening in breast area; red, scaly patchy breast
skin; nipple invertion and peau d’ orange (
inflammatory).
� For paget’s type: itching, burning crusting or
ulceration of nipple.
• \DOC: estrogen antagonist( tamoxifen) and other
chemo drugs.
Other Tx: Lumpectomy or mastectomy with axillary
node dissection followed by radiation.
• Nurse concern: Drainage tube care; ROM exercises;
ways to prevent complications. Screening for women.
diannemaydee
BREAST CANCER
diannemaydee
• 1. Breast self examination is an important tool in detecting early stages of Breast Cancer. What is being checked when doing BSE?
• A. Thickness and Lumps
• B. Malignant or Benign Tumors
• C. Calcification of Breast
• D. Cancerous Lesions
diannemaydee
• 2. The nurse puts a folded towel under the Left
shoulder of the Client to be examined for clinical
BSE. Why is this so?
• A. To make the left shoulder nearer to the hands
of the clinician for palpation
• B. To make the pectoralis muscle prominent,
toning the breast tissue for better palpation
• C. To put the breast in a more lateral position to
better ease the palpation
• D. To balance the breast in the client’s chest to
better eases the palpation
diannemaydee
• 3. Anita is performing BSE and she stands in front of the Mirror. The rationale for standing in front of the mirror is to check for:
• A. Unusual discharges coming out from the breast
• B. Any obvious malignancy
• C. The Size and Contour of the breast
• D. Thickness and lumps in the breast
diannemaydee
• 4. An emerging technique in screening for Breast Cancer in developing countries like the Philippines is:
• A. Mammography once a year starting at the age of 50
• B. Clinical BSE Once a year
• C. BSE Once a month
• D. Pap smear starting at the age of 18 or earlier if sexually active
diannemaydee
• 5. The most common complication associated post op mastectomy is:
• A. Hemorrhage
• B. Lymphedema
• C. Self esteem disturbance
• D. Pain
diannemaydee
• 6. Post op mastectomy, The nurse would do the following to prevent unnecessary injury to the Arm of the client except:
• A. BP taking from the affected arm
• B. No IM Injection to the affected arm
• C. Elevating the affected arm
• D. Preventing trauma and injury to the affected arm
diannemaydee
• 7. Stage 3 of breast development, according to Tanner, occurs when:
• A. the areola (a darker tissue ring around the nipple) develops.
• B. breast budding begins.
• C. the areola and nipple form a secondary mound on top of breast tissue.
• D. the breast develops into a single contour
diannemaydee
• the areola (a darker tissue ring around the nipple) develops.
• Stage 3 also involves further enlargement of breast tissue.
• breast budding begins.
• Breast budding is the first sign of puberty in a female.
• the areola and nipple form a secondary mound on top of breast tissue.
• In stage 4, the nipple and areola form a secondary mound on top of breast tissue.
• the breast develops into a single contour
• In stage 5, the female demonstrates continued development of a larger breast with a single contour.
diannemaydee
• Pathology: squamous cell carcinoma
• Risk: low socio-economic status, early 1st marriage, early and frequent intercourse, multiple sex partners, high parity, poor post partum care and hygiene, HPV, teen age smoking
• Dx: Pap smear, colposcopy, endocervical curettage, conization, schiller’s test.
• Cardinal sign: vaginal bleeding post coital and post menstrually; foul discharges, pelvic pain
• DOC: cisplatin; radiatio therapy
• Surgical Tx: TAH-BSO or pelvic exenteration with permanent ileostomy or colostomy
• Nurse concern: nuns and jews have lowest incidence; IEC on annual gynecologic exam
diannemaydee
GI neoplasm, surgery and
colostomy
diannemaydee
• 1. What is the involvement of her total gastrectomy?
• A. removal of the stomach only
• B. removal of the stomach with anastomosis of the esophagus to the jejunum
• C. removal of the ovary and fallopian tube
• D. removal of the stomach with anastomosis of the duodenal to jejunum
diannemaydee
• GI Neoplasm
• Pathology: proliferation of undifferentiated GI cells.
• Risk: tobacco use ( oral ); alcohol and tobacco ( esophageal); genetics, gastric irritants ( stomach); low fiber, high fat, polyps, ulcerative colitis ( intestinal ).
• Dx: guiac test, colonoscopy, bronchoscopy, endoscopy, biopsy, barium enema, CEA
diannemaydee
• Cardinal sign:
• Oral: leukoplakia, erythroplakia, dysphagia
• Esophageal: dysphagia, respiratory complication
• Stomach: gastric discomfort, anorexia
• Ascending Colon: mild bleeding, anorexia, fatigue, weight loss
• Descending colon: change in bowel habits and stools
• DOC: chemo/radiation therapy
• Nurse concern: Standard post-op care; emotional support
diannemaydee
• Colon cancer: risk factors
• “HULA”Heredity/ Hereditary diseasesUlcerative colitisLow fiber, high fat dietAdenomatous polyps
diannemaydee
• 2. Your operative nursing assessment after surgery:
• A. note and report excessive bleeding only
• B. assess for excessive secretions from the operative site
• C. ensure that the NG tube is detached from suction apparatus
• D. check the drainage from the NG tube everyday
diannemaydee
• 3. A nurse is monitoring drainage from a nasogastric(NG) tube in a client who had a gastric resection. No drainage has been noted during the past 4 hours and the client complains of severe nausea. The most appropriate nursing action would be to:
• A. reposition the tube
• B. irrigate the tube
• C. notify the physician
• D. medicate for nausea
diannemaydee
• 4. He underwent total gastrectomy, dumping syndrome may occur and the least symptoms he may experience would be:
• A. feeling of soreness
• B. weakness
• C. feeling of fullness
• D. diaphoresis
diannemaydee
• 5. To prevent dumping syndrome the following includes your nursing care except:
• A. serve dry meals
• B. allow him to walk for a while after eating
• C. instruct him to lie down after eating
• D. giving of fluids after meals must be avoided
diannemaydee
• 6. Which of the following gastrointestinal condition is known to predispose to Cancer of the colon?
• A. hemorrhoids
• B. intussusception
• C. islated colonic polyps
• D. pyloric stenosis
diannemaydee
• 7. A nurse is teaching a client about the modifiable risk factors that can reduce the risk for colorectal cancer. The nurse places highest priority on discussing which of the following risk factors with this client?
• A. personal history of ulcerative colitis or gastrointestinal (GI) polyps
• B. distant relative with colorectal cancer
• C. age over 30 years
• D. high-fat, low fiber diet
diannemaydee
• Situation: Benjie 59 years old male was admitted to the hospital complaining of nausea, vomiting, weight loss of 20 lbs, constipation and diarrhea. A diagnosis of carcinoma of the colon was made.
• 8. A sigmoidoscopy was performed as a diagnostic measures. What position Benjie should assume for hi examination?
• A. knee-chest
• B. Sim’s
• C. Fowler’s
• D. Trendelenburg
diannemaydee
• 9. A home care nurse visits a client with bowel cancer who recently received a course of chemotherapy. The client has developed stomatitis. The nurse avoids telling the client to:
• A. drink foods and liquids that are cold
• B. eat foods without spices
• C. maintain a diet of soft foods
• D. drink juices that are not citrus
diannemaydee
• 10. A nurse has provided instructions to a client who is receiving external radiation therapy. Which of the following if started by the client would indicate a need for further instructions regarding self-care related to the radiation therapy?
• A. “I need to avoid exposure to sunlight?”
• B. “I need to wash my skin with a mild soap and pat dry”
• C. “I need to apply pressure to the irritated area to prevent bleeding”
• D. “I need to eat a high-protein diet”
diannemaydee
• 1. Following abdominal surgery, a client complaining of “gas pains” will have a rectal tube inserted. The client should be positioned on his:
• A. left side, recumbent
• B. left side, sims
• C. right side, semi-fowler’s
• D. left side, semi-Fowler’s
diannemaydee
• 2. A client who has just returned home following ileostomy surgery will need a diet that is supplemented:
• A. potassium
• B. vitamin B12
• C. sodium
• D. fiber
diannemaydee
• 3. The nurse instructs the ileostomy client to do which of the following as part of essential care of the stoma?
• A. cleanse the peristomal skin meticulously
• B. take in high-fiber foods such as nuts
• C. massage the area below the stoma
• D. limit fluid intake to prevent diarrhea
diannemaydee
• 4. The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse evaluates that the client did not fully understand the instructions if the client stated that eating which of the following foods makes the stool less watery?
• A. pasta C. bran
• B. boiled rice D. low-fat cheese
diannemaydee
• 5. The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperatively period for which of the following most frequent complications of this type of surgery?
• A. intestinal obstruction
• B. fluid and electrolyte imbalance
• C. malabsorption of fat
• D. folate deficiency
diannemaydee
• 6. A client is about to undergo an Abdominal Perineal resection. An appropriate health teaching for these clients is:
• A. Changing sterile dressing
• B. Wound care
• C. Passive ROM exercises
• D. Colostomy care
diannemaydee
• 7. The nurse is caring for a client post-operatively following the creation of a colostomy. Which of the ff. nursing diagnosis does the nurse include in the plan of care?
• A. altered nutrition; more than body requirements
• B. body image disturbance
• C. fear related to poor diagnosis
• D. sexual dysnfunction
diannemaydee
• 8. The doctor performed a colostomy, post operative nursing care include:
• A. keeping the skin around the opening clean and dry
• B. limiting visitors
• C. withholding
• D. limiting fluid intake
diannemaydee
• 9. The nurse is teaching a client with a new colostomy how to apply an appliance to a colostomy. How much skin should remain exposed between the stoma and the ring of the appliance?
• A. 1/8 inch
• B. ½ inch
• C. ¾ inch
• D. 1 inch
diannemaydee
• 10. During the irrigation of the colostomy, Benjiecomplains of abdominal cramps, the nurse should:
• A. discontinue the irrigation
• B. clamp the catheter for a few minutes
• C. advance the catheter about one inch
• D. add color water
diannemaydee
• 11. If colostomy irrigation is done, the height of the irrigator can must be how many inches above the stoma?
• A. 14-18 inches
• B. 18-20 inches
• C. 20-24 inches
• D. 10-14 inches
diannemaydee
• 12. Which statements provided the best evidence that a client with colostomy is adjusting to the change in body image?
• A. the client wears loose-fitting garments
• B. the client takes a shower each day
• C. the client empties the appliance
• D. the client avoids foods that form gas
diannemaydee
• 13. The client who has undergone creation of a colostomy has a nursing diagnosis of Body Image disturbance. The nurse evaluates that he client is making the most significant progress toward identified goals if the client:
• A. watches the nurse empty the ostomy bag
• B. looks at the ostomy site
• C. reads the ostomy product literature
• D. practices cutting the ostomy appliance
diannemaydee
• 14. The client with a new colostomy is concerned about odor from stool in the ostomy drainage bag. The nurse should teach the client to include which of the following foods in the diet to reduce odor?
• A. yogurt C. cucumbers
• B. broccoli D. eggs
diannemaydee
• 15. The nurse is giving dietary instruction for the client who has a new colostomy. The nurse encourages the client to eat foods representing which of the following diets for the first 4 to 6 weeks postoperatively?
• A. high protein C. low calorie
• B. high carbohydrates D. low residue
diannemaydee
• 16. A client scheduled for colostomy surgery. An appropriate preoperative diet will include:
• preoperative diet will include:
• A. broiled chicken, baked potato, and wheat bread
• B. ground hamburger, rice, and salad
• C. broiled fish, rice, squash, and tea
• D. steak, mashed potatoes, raw carrots, and celery
diannemaydee
• 17. Following Gastric Resection, patients are prone to developing Dumping Syndrome. Which of the following types of dietary intake by the patient would be MOST helpful to either reduce or prevent this syndrome from developing?
• A. Moderate fat, low carbohydrate
• B. High fat, high carbohydrate
• C. Low fat, low carbohydrate
• D. Moderate fat, high carbohydrate
diannemaydee
• 18. Following Total Gastrectomy patients will require vitamin replacement. Of the following, which vitamin is ESSENTIAL and MUST be given throughout life:
• A. Vitamin C
• B. Vitamin B6
• C. Vitamin D
• D. Vitamin B12
diannemaydee
Bladder Cancer
diannemaydee
Bladder Cancer
• Most common site of urinary tract cancer
• Males 50 – 70 y/o
• Unknown cause
diannemaydee
Bladder Cancer
• Risk Factors
- smoking
- pelvic radiation
- Cyclophosphamide
- chronic cystitis
- Bladder calculi
- Schistosomiasis
- dust, fumes or dyes
- rubber, leather, paint
diannemaydee
Bladder Cancer
Signs and Symptoms
• Painless hematuria (most common & first sign)
• Urgency, dysuria, frequency w/ small volumes
of urine
• Lumbar pain
• Asymptomatic
• Hydronephrosis
• Renal failure
diannemaydee
Diagnostic Studies
• Urinalysis / culture
• Excretory urography
• Cystoscopy with biopsy
• Renal ultrasound
• CT Scan
diannemaydee
ManagementSurgery
• Bladder resection (Cystectomy)
• Ileal conduit
- external collection device needed
- proper fitting to prevent urine leak to the skin
- skin care with warm water & mild soap
• Complications:
- obstruction to urine flow via small intestines (edema)
- infection
- stoma prolapse
- calculi
- electrolyte imbalance
diannemaydee
Management
• Ureterostomy
- one or 2 ureters are externalized to the abdominal wall
- ureteral stoma is created
- external collection device needed
- infection is a potential hazard
- increase fluid intake
diannemaydee
Management
• Nephrostomy
- catheter inserted in kidney through an incision
- to drain urine while ureteralinflammation from trauma or calculus is present
- assess for infection & blockage of the catheter
- do not irrigate
diannemaydee
Management• Ureterosigmoidostomy
- no external collection device
- passage of flatus includes leak of urine
- infection is possible
diannemaydee
Management• Radiation
• Chemotherapy
- intravesical instillation with Mitomycin C (non-invasive bladder CA)
- CMDV (Cisplatin, Methotrexate, Doxurubicin, Vincristine)
diannemaydee
Bladder CancerNursing Care
• Allow time for client to verbalize fears of surgery, cancer, death & body-image alterations
• Prepare bowel pre-operatively (laxatives, antibiotics, enemas) as ordered
• Maintain patency of drainage system
• Ileal conduit care
- maintain urinary drainage bag
- cleanse skin around stoma w/ soap & water
- encourage self-care
diannemaydee
• 1. Which of the following is a sign that the nurse could observe in acute transplant rejection in patient after kidney transplant?
• A. Polyuria
• B. Fever and chills
• C. Weight loss
• D. Rising BUN and Creatinine more than 20%
diannemaydee
• 2. A male client who is to have a kidney transplant asks the nurse how long will he be taking azathioprine [ IMURAN ], cyclosporine and prednisone. The nurse recognizes that the client understood the teaching when he states “I must take these medications:
• A. For the rest of my life.”
• B. Until the surgery is over.”
• C. Until the anastomosis heals.”
• D. During the post operative period.”
diannemaydee
• 3. After kidney transplant, the nurse should observe the client for symptoms of rejection which includes:
• A. Polyuria and jaundice
• B. Fever and weight gain
• C. Hematuria and seizures
• D. Moonface and muscle atrophy
diannemaydee
Kidney/ Bladder Cancer• Pathology: tumor of the kidney which metastasize in lungs,
mediastinum, bone, lymph node, liver and CNS.• Risk: males over 50, smoking, obesity, calculi, urban
environment, industrial chemicals, analgesic abuse.• Dx: renal USG and CT scan
• Cardinal sign: triad: gross hematuria; flank pain; and , palpable abdominal mass.
• DOC: interferon alpha ( immunotherapy) and other chemo drugs +++ radiation therapy.
• Surgery: Radical nephrectomy
• Nurse concern: Standard post op care. Hydrate especially during “hot” season or exercise; Infection precaution; Void if there’s urge or after intercourse; Avoid trauma to the remaining kidney.
diannemaydee
• Nephrectomy: indications
4 T's:TraumaTumorTBTransplantation
diannemaydee
THANK YOU!!!
DIANNE MAYDEE MANDAL RN, USRN, REMT-B, AREMT-B
http://stuffednurse.blogspot.com
This is a copy of my old supplemental slides for students
from 2 years ago, when I was just starting..only my name
has been edited, have acquired a few more name appendages since those days =)